Timing and Modality of Kidney Replacement Therapy in Children and Adolescents

Introduction: The choice and timing of kidney replacement therapy (KRT) is influenced by clinical factors, laboratory features, feasibility issues, family preferences, and clinicians' attitudes. We analyzed the factors associated with KRT modality and timing in a multicenter, multinational prospective pediatric cohort study. Methods: A total of 695 pediatric patients with chronic kidney disease (CKD) enrolled into the Cardiovascular Comorbidity in Children with CKD (4C) study at age 6 to 17 years with estimated glomerular filtration rate (eGFR) of 10 to 60 ml/min per 1.73 m(2) were investigated. Competing risk regression was performed to identify factors associated with initiation of dialysis or preemptive transplantation (Tx), including primary renal diagnosis, demographics, anthropometrics, and laboratory parameters. Results: During the 8-year observation period, 342 patients (49%) started KRT. Of these, 200 patients started dialysis, whereas 142 patients underwent preemptive Tx. A lower eGFR at enrolment (Hazard ratio [HR]: 0.76 [95% confidence interval: 0.74-0.78]), a steeper eGFR slope (HR: 0.90 [0.85-0.95], and a higher systolic blood pressure SD score (SDS) (HR: 2.07 [1.49-2.87]) increased the likelihood of KRT initiation. Patients with glomerulopathies were more likely to start dialysis than children with congenital anomalies of the kidneys and urinary tracts (CAKUT) (HR: 3.81 [2.52-5.76]). Lower body mass index (BMI) SDS (HR: 0.73 [0.6-0.89]) and lower hemoglobin (HR: 0.8 [0.72-0.9]) were associated with higher likelihood of dialysis. A significant center effect was observed, accounting for 6.8% (dialysis) to 8.7% (preemptive Tx) of explained variation. Conclusion: The timing and choice of KRT in pediatric patients is influenced by the rate of kidney function loss, the underlying kidney disease, nutritional status, blood pressure, anemia and center-specific factors

Supraventricular tachycardia following insertion of a central venous catheter.

PubMed ID: 19861871Placement of central venous catheters (CVCs) in patients is associated with several risks including endocardial injury and dysrhythmias. In addition, CVC extending into intracardiac chambers can provoke premature atrial and ventricular complexes, which have been reported to initiate supraventricular tachycardia (SVT). A 15-year-old boy with end-stage renal failure developed SVT after insertion of a CVC

A rare cause of chronic renal failure in a girl with elevated serum uric acid level: Answer

PubMed ID: 19727840[No abstract available

Pull or Wait: How to Optimize Query Age of Information

We study a pull-based status update communication model where a source node submits update packets to a channel with random transmission delay, at times requested by a remote destination node. The objective is to minimize the average query-age-of-information (QAoI), defined as the average age-of-information (AoI) measured at query instants that occur at the destination side according to a stochastic arrival process. In reference to a push-based problem formulation defined in the literature where the source decides to update or wait at will, with the objective of minimizing the time average AoI at the destination, we name this problem the Pull-or-Wait (PoW) problem. We identify the PoW problem in the case of a single query as a stochastic shortest path (SSP) problem with uncountable state and action spaces, which has not been solved in previous literature. We derive an optimal solution for this SSP problem and use it as a building block for the solution of the PoW problem under periodic query arrivals